Roberto A. Lima
University of São Paulo
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Featured researches published by Roberto A. Lima.
American Journal of Surgery | 1994
Jacob Kligerman; Roberto A. Lima; Jose R. Soares; Lygia Anne F. Prado; Fernando Luiz Dias; Emilson Q. Freitas; Luis O. Olivatto
BACKGROUNDnRecent studies in patients with previously untreated T1 and T2 squamous cell carcinoma (SCC) of the tongue and floor of the mouth have shown a relationship between tumor thickness, neck metastasis, and survival. Our study was conducted to determine the indication of elective neck dissection in patients with early oral cavity SCC.nnnPATIENTS AND METHODSnSixty-seven patients were stratified by stage (T1 and T2 NO), and those in each stage were randomized to receive one of two types of treatment; resection alone (RA) or resection plus elective supraomohyoid neck dissection (RSOND). Fifty-two patients (78%) were men and 15 (22%) were women. The median age was 57 years old (range 34 to 95).nnnRESULTSnTwenty-six (39%) patients had tumor in the floor of the mouth and 41 (61%), in the tongue. Using the criteria of the Union Internationale Contre le Cancer (UICC), 1987, we classified 31 tumors (46%) as T1 lesions and 36 (54%) as T2 lesions. Thirty patients had a tumor thickness < or = 4 mm and 37 had a tumor thickness > 4 mm. Thirty-three (49%) patients were treated with RA, and 34 patients (51%) were treated with RSOND. Seven (21%) patients of the RSOND group had occult cervical metastasis. There were recurrences in 14 (42%) patients of the RA group and 8 (24%) patients of the RSOND group. The disease-free survival rates at 3.5 years for RA and RSOND patients were 49%, and 72%, respectively. The impact of sex, age, site, cancer stage, and tumor thickness was assessed by the Mantel-Haenszel chi-square procedure. Later stage (P = 0.05) and increased tumor thickness (P = 0.005) were significantly associated with treatment failures.nnnCONCLUSIONnNeck dissection remains mandatory in the early stage of oral SCC, because of better survival rates compared to RA and the poor salvage rate. In particular, patients with tumor thickness > 4 mm treated with RSOND had significant benefit on disease-free survival.
Otolaryngology-Head and Neck Surgery | 2005
Roberto A. Lima; Marcos Tavares; Fernando Luiz Dias; Jacob Kligerman; M.F. Nascimento; Mauro Marques Barbosa; Claudio Roberto Cernea; Jose R. Soares; Izabella Costa Santos; Scheylla Salviano
OBJECTIVE: To analyze the factors in parotid malignant epithelial tumors influencing recurrences and disease-specific survival. METHODS: We retrospectively reviewed the files of 150 patients treated at our institution, from 1974 to 1998. Twenty-four patients were not treated by surgery and were excluded from this study. The remaining 126 patients were treated with surgery and 74 patients had postoperative radiotherapy. Thirty-three patients were treated with parotidectomy plus neck dissection. Neck lymph node metastasis was found in 22 patients, 5 patients had occult neck metastasis, and 4 periparotid lymph nodes metastasis. The mean age was 49 years old. According to the UICC/1997 TNM Classification, 49 patients were stage I, 27 stage II, 22 stage III, and 28 stage IV. The influence of selected factors on the 10 year disease-specific survival was analyzed using the Kaplan-Meier actuarial method and the log-rank test. RESULTS: Forty patients had mucoepidermoid carcinoma, 18 patients adenocarcinoma NOS, 18 patients acinic cell carcinoma, 15 patients adenoid cystic carcinoma, 11 patients malignant mixed tumor, 11 patients salivary duct carcinoma, and 13 patients other pathology. Twenty-five patients had recurrences: 17 had local recurrences, 4 patients had neck recurrences, and 4 were loco-regional recurrences. Five factors influenced negatively the prognosis: 1) T stage (p.00001), 2) grade (p.00001), 3) + lymph nodes (p.0007), 4) facial nerve dysfunction (p.0001), and 5) age (p.004). Patients with high-grade tumors and high-stage tumors had the worst prognosis according to the multivariate analysis. The 10-year disease-specific survival was 97% for stage I, 81% for stage II, 56% for stage III, and 20% for stage IV. CONCLUSION: The grade of the tumor and stage were the most important prognostic factor.
Otolaryngology-Head and Neck Surgery | 2001
Fernando Luiz Dias; Jacob Kligerman; Geraldo Matos de Sá; Roberto Alfonso Arcuri; Emilson Q. Freitas; Terence Pires de Farias; FáTima Matos; Roberto A. Lima
A retrospective study was undertaken of patients with T1N0M0 squamous cell carcinoma of the oral tongue and floor of the mouth who underwent surgical treatment between 1985 and 1995. Evaluation of two groups of patients (neck dissection versus observation) was made according to the management of the neck. Results were obtained regarding the presence of occult metastases, recurrence in the neck, treatment failure, results of salvage treatment, and disease-free survival. Forty-nine patients underwent surgical treatment: 25 resection of primary and 24 resection plus neck dissection. Overall incidence of regional metastases was 24.5%. Eight patients (16%) developed recurrence of the disease. Seven (14%) had regional recurrences (including 1 with distant metastases) and 1(2%) had local recurrence. Twenty-four percent of patients from the resection of primary group developed neck recurrences in comparison with 4% of the resection plus neck dissection group (P = 0.05). Overall salvage rate was 37.5%. Second primary tumors developed in 16% of patients. Patients who underwent elective neck dissection had a 23% higher disease-free survival rate compared with those who underwent resection of the tumor alone (P = 0.03). The findings of this study stress the importance of control of the neck in early oral cancer. Elective neck dissection significantly improved regional control of the disease.
Otolaryngology-Head and Neck Surgery | 2006
Fernando Luiz Dias; Roberto A. Lima; Jacob Kligerman; Terence Pires de Farias; Jose R. Soares; Gabriel Manfro; Geraldo Matos de Sá
OBJECTIVE: To analyze the therapeutic implications of the distribution of neck metastases (NM) in patients with squamous cell carcinoma (SCC) of the tongue and the floor of the mouth (FOM). PATIENTS AND METHODS: From January 1987 through December 1997, 339 previously untreated patients with T1-2 N0 M0 SCC of the tongue and the FOM underwent primary surgical treatment in our institution. A retrospective review of the pathology reports and outcome of these patients was made to ascertain the prevalence and distribution of NM. Patients were grouped by clinical neck status at the time of neck dissection: elective neck dissection (END) in the NO neck and subsequent therapeutic dissection (STD) in the neck observed which converted clinically to N+ or regional recurrences after END. All patients were classified according to the American Joint Committee on Cancer (AJCC)/UICC 2002 TNM classification. RESULTS: All patients underwent surgical treatment of the primary cancer and had negative margins at frozen section. Overall incidence of NM was 41.3%. Twenty-seven point eight percent of T1 N0 M0 and 48.2% of T2 N0 M0 patients developed NM (P = .0004). Occult neck metastases occurred in 24.1% of patients. Clinically, N+ metastases occurred in 23.6% of patients. The overall incidence of NM in levels IV and V was 8.5%. Neck level IV nodes were involved in only 1.5% of patients in the END group versus 23.7% in the STD group (P < 0.001). Level V was always associated to nodal metastases in other neck levels. Only 2% of patients in our study presented “skip metastases” in the neck. CONCLUSIONS: Neck levels I and II were at great risk for the development of NM (46.9% and 75.3% respectively). Levels IV (6.5%) and V (2%) were rarely involved in our group of patients. The results found in this study support the indication of supraomohyoid neck dissection for N0 and a more comprehensive neck dissection (levels I-V) for N+ patients in Stage I-II SCC of the tongue and FOM. EBM rating: C-4
Head and Neck-journal for The Sciences and Specialties of The Head and Neck | 2006
Roberto A. Lima; Emilson Q. Freitas; Fernando Luiz Dias; Mauro Marques Barbosa; Jacob Kligerman; Jose R. Soares; Izabella Costa Santos; Ricardo M. Rocha; Claudio Roberto Cernea
Supracricoid laryngectomy with cri‐cohyoidoepiglottopexy (CHEP) is a conservative surgical procedure indicated in selected cases of advanced glottic carcinoma.
Otolaryngology-Head and Neck Surgery | 2001
Roberto A. Lima; Emilson Q. Freitas; Jacob Kligerman; Fernando Luiz Dias; Mauro Marques Barbosa; Geraldo Matos de Sá; Izabella Costa Santos; Terence Pires de Farias
OBJECTIVES: To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy. STUDY DESIGN: A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease-free survival was 75% for T2 and 79% for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near-total laryngectomy, regarding the extent of the lesion.
Auris Nasus Larynx | 2010
Claudio Roberto Cernea; Lenine Garcia Brandão; Flávio C. Hojaij; Dorival De Carlucci; Fábio Luiz de Menezes Montenegro; Caio Plopper; Felipe Augusto Brasileiro Vanderlei; Renato Gotoda; Fernando Luis Dias; Roberto A. Lima
BACKGROUNDnIn ancient times, operations on the thyroid gland caused unacceptable morbidity and mortality. Only after the landmark work of Kocher, the technical principles of thyroidectomy were solidly established, and are still valid nowadays.nnnMETHODSnRevision article on practical suggestions to decrease morbidity associated with thyroidectomy, as well as warning against common pitfalls that the surgeon may encounter.nnnRESULTSnThe following subjects are objectively addressed: how to manage upper airway obstruction, how to avoid non-esthetic scars and how to recognize the most prevalent anatomic variations concerning the recurrent nerve, the external branch of the superior laryngeal nerve and the parathyroid glands, in order to decrease operative morbidity.nnnCONCLUSIONnThe Head and Neck Surgeon must be fully aware of the complex anatomy of the central visceral compartment of the neck, as well as must be prepared to handle some complications of thyroidectomy that can be life-threatening.
American Journal of Surgery | 1997
Roberto A. Lima; Emilson Q. Freitas; Jacob Kligerman; Fernando P. Paiva; Fernando Luiz Dias; Mauro Marques Barbosa; Geraldo Matos de Sá; Jose R. Soares
BACKGROUNDnIn order to assess whether near-total laryngectomy (NTL) could successfully reach the cure and preserve the voice in advanced laryngeal cancer, we studied 28 patients with T3/T4 squamous cell carcinoma of the larynx treated with NTL in our institution.nnnMETHODSnA retrospective analysis has been carried out from 1990 through 1994. We classified 24 patients as Stage III and 4 patients as Stage IV. All patients had lateral neck dissection. Survival was analyzed under the Kaplan-Meier method.nnnRESULTSnTwenty-six patients achieved voice preservation. Two patients in the bilateral neck dissection group had a metastatic lymph node on the opposite side. No patient had local recurrence. Three patients died of the disease, and 1 patient was salvaged with neck dissection. Three-year disease-free survival was 85%.nnnCONCLUSIONnThis technique is useful in the treatment of selected cases of advanced laryngeal cancer and achieves local control of the lesion in all cases. The survival is comparable with that of patients submitted to total laryngectomy, regarding the extent of lesion. Voice preservation can be achieved in most cases.
Otolaryngology-Head and Neck Surgery | 2005
Fernando Luiz Dias; Roberto A. Lima; Gabriel Manfro; Mauro Marques Barbosa; Scheilla Salviano; Ricardo M. Rocha; Amanda Marques; Claudio Roberto Cernea; Jacob Kligerman
Objective: To assess the oncological efficacy of selective neck dissection (SND) in patients with T3-4 N0 laryngeal squamous carcinoma. Subjects and Methods: A total of 327 patients underwent 654 neck dissections; each side of the neck was individually evaluated. Results: Three percent of patients who had SND developed regional recurrence (RR) in comparison with 11.7 percent of patients who underwent modified radical neck dissection (MRND) (P = 0.005). Only 3 (0.9%) patients developed RR outside the field of SND. The presence of extracapsular extension (P = 0.002) in node-positive (pN+) group and of microvascular invasion (P = 0.007), together with the type of neck dissection (ND) (P = 0.0003) in node-negative (pN0) group had statistical impact on RR. The development of RR significantly affected disease-specific survival (P = 0.0001). Equivalent rates of RR were found in pN+ (2.6%) or pN0 (3.2%) patients treated with SND (P = 0.98) as well as in pN+ patients who underwent SND (2.6%) or MRND (4.7%) (P = 0.85). Conclusion: This study confirmed the adequacy of SND as a satisfactory staging and therapeutic procedure, and suggests its use in the treatment of limited node-positive (N+) neck.
Phytochemistry | 1975
Roberto A. Lima; Nidia C. Franca; Pedro P. Diaz Diaz; Otto R. Gottlieb
Abstract The trunk wood of Iryanthera coriacea Ducke (Myristicaceae) contains six compounds which belong to the recently discovered 1,3-diarylpropane type of flavonoids, 1-(2-hydroxy-4-methoxyphenyl)-3-(3,4-methylenedioxyphenyl)-propane, 1-(2,4-dihydroxyphenyl)-3-(3,4-methylenedioxyphenyl)-propane, 1-(4-methoxyphenyl)-3-(2-hydroxy-4,5-methylenedioxyphenyl)-propane, 1-(4-hydroxy-2-methoxy-phenyl)-3-(4-hydroxy-3-methoxyphenyl)-propane, 1-(2,4-dihydroxyphenyl)-3-(2-methoxy-4,5-methylene-dioxyphenyl)-propane, 1-(2,4-dihydroxy-3,5-methylphenyl)-3-(2-hydroxy-4,5-methylenedioxyphenyl)-propane.